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Background:  Ambient particulate matter is a public health concern in East Asia as it contributes to a growing number of all-cause and cancer deaths. This study aimed to estimate lung cancer death attributable to ambient particulate matter (PM) < 2.5 μm (PM 2.5 ) in East Asia countries.   Methods:  The attributable death rates of lung cancer were estimated based on the calculation of population attributable fraction. We performed joinpoint regression analysis and age-period-cohort (APC) model to estimate temporal trends of the attributable death to PM 2.5 .   Results:  In 2019, PM 2.5  was estimated to have caused 42.2% (nearly 0.13 million) of lung cancer deaths in East Asia men. During 1990–2019, the increase in age-standardized death rates of lung cancer attributable to PM 2.5  was highest in China, which increased by 3.50% in males and 3.71% in females. The death rate caused by PM 2.5  also significantly increased in the Democratic People's Republic of Korea (2.16% in males; 3.06% in females). Joinpoint analysis showed that the rates generally increased in younger and older people in both the Democratic People's Republic of Korea and Mongolia, while it only increased in elderly people in other countries'. Age effect from APC analysis demonstrated the risk of lung cancer death attributable to PM 2.5  generally increased from young to old age. Period effect indicated that from 1994–1998 to 2019–2023 period risk continuously increased by 1.77, 1.68, and 1.72 times in China, the Democratic People's Republic of Korea, and Japan, respectively. The period risk decreased from 1999 to 2009 and subsequently increased from 2009 to 2019 in both the Republic of Korea and Mongolia.   Conclusions:  The death rate of lung cancer attributable to PM 2.5  is increasing in the Democratic People's Republic of Korea, Mongolia, and China. In East Asia, China is facing the highest attributable death rate in recent decades. The period effect suggested a remarkably increased risk of lung cancer death caused by PM 2.5  in China, the Democratic People's Republic of Korea, and Japan during the long-term period. It is recommended that the governments of these countries should continuously concentrate on particulate matter pollution governance and improvement.

Lung Cancer Death Attributable to Long-Term Ambient Particulate Matter (PM2.5) Exposure in East Asian Countries During 1990–2019